10/23/2019 NTENNIALCARE New Mexico Human Services Department Medical Assistance Division Long ‐ Term Services and Supports Bureau October 2019 Centennial Care • Centennial Care began 1/1/14 • 1115 Waiver approved by Centers for Medicaid and Medicare (CMS) • Renewed 1115 Waiver 1/1/19 • Integrated managed care program that offers all health care services to eligible recipients, delivered by three managed care organizations (MCOs) • Blue Cross Blue Shield, Presbyterian, Western Sky • Physical health, behavioral health, long ‐ term services and supports (LTSS) 2 1
10/23/2019 Centennial Care Community Benefits • The Community Benefit (CB) is the name for the home and community based long ‐ term care program in Centennial Care • Provides in ‐ home/community services so that members remain in the community and out of nursing facilities • Agency ‐ based (ABCB) or self ‐ directed (SDCB) model 3 Community Benefit (CB) Eligibility • To be eligible for the community benefit, individuals must meet a nursing facility level of care (NF LOC) and have an assessed need for services • NF LOC=individual must require assistance with two or more activities of daily living (ADLs) • Individual must also qualify financially with the Income Support Division (ISD) 4 2
10/23/2019 Community Benefit (CB) Eligibility Two ways to enter the CB: 1 . If already eligible/enrolled in Medicaid, member can let MCO/care coordinator know that he/she needs CB services. • MCO will assess member for NF LOC and CB services (comprehensive needs assessment) • If member meets NF LOC, MCO will develop comprehensive care plan based on the member's assessed needs 5 Community Benefit (CB) Eligibility 2 . If individual has applied for Medicaid and is not eligible he/she should contact the Aging and Disability Resource Center (ADRC) to be placed on the Central Registry. • ADRC will perform an assessment of needs by telephone • ADRC will assign an allocation category • Regular, expedite, community reintegration, exception • HSD Allocations Unit sends packet including Medicaid application to individual for completion, and assists with the process 6 3
10/23/2019 Community Benefit (CB) Eligibility • If an individual has already been placed on the central registry, and his/her health condition changes, he/she should contact the ADRC for a new assessment • If member is in Medicaid (receiving the CB) and loses eligibility due to age or excess income, he/she should contact the ADRC to request an exception allocation to ensure continuity of care • ADRC: 1 ‐ 800 ‐ 432 ‐ 2080 www.nmaging@state.nm.us 7 Community Benefit Services Individuals under 21 Agency Based Self ‐ Directed Adult Day Health X Assisted Living X Behavior Support Consultation X X X Community Transition Services * X Customized Community Supports X Emergency Response X X Environmental Modifications * X X X Home Health Aide X X Personal Care X Self ‐ Directed Personal Care X Nutritional Counseling X X Private Duty Nursing X X Related Goods * X X Respite X X X Skilled Maintenance Therapies X X Specialized Therapies * X X Start ‐ Up Goods * X X Transportation (non ‐ medical) * X 8 * Limits and restrictions may apply 4
10/23/2019 Agency Based Community Benefit ABCB members under the age of 21: Are able to receive PCS and other services through EPSDT Will most likely only be eligible for Respite (300 hours per year limit) and possibly Behavior Support Consultation Based on need, may be eligible for other services offered under the SDCB model such as related goods and specialized therapies • 120 day requirement • Minors cannot be their own Employer of Record 9 Self ‐ Directed Community Benefit • CB members can switch to the SDCB model anytime after receiving services for at least 120 days in ABCB • Must work with MCO/care coordinator • Support Broker • Employer of Record requirements • Added responsibilities of being the employer of providers • hire, fire, train, ensure background checks are completed, submit timesheets and invoices to Conduent, arrange for back ‐ up caregivers, coordinate with NM Department of Labor 10 5
10/23/2019 Community Benefit Rule and Policy Rule: • http://164.64.110.134/parts/title08/08.308.0012.html Policy: • http://www.hsd.state.nm.us/providers/managed ‐ care ‐ policy ‐ manual.aspx 11 Contact Information • Tallie Tolen, Bureau Chief (505) 476 ‐ 7013 or Tallie.tolen@state.nm.us • Jeannette Gurule, Community Benefit Manager (505) 827 ‐ 7765 or Jeannette.C.Gurule@state.nm.us • ADRC: 1 ‐ 800 ‐ 432 ‐ 2080 www.nmaging@state.nm.us 12 6
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